Wisconsin Code § 635.18

Fair marketing standards
Open in Lexace · Ask the AI about this section
(1) Every small employer insurer shall actively market health benefit plan coverage
to small employers in the state.
(2) (a) Except as provided in par. (b), a small employer insurer or an intermediary may not, directly or indirectly, do any of
the following:
1. Discourage a small employer from applying, or direct a
small employer not to apply, for coverage with the small employer
insurer because of the health status, claims experience, industry,
occupation or geographic location of the small employer.
2. Encourage or direct a small employer to seek coverage
from another insurer because of the health status, claims experience, industry, occupation or geographic location of the small
employer.
(b) Paragraph (a) does not prohibit a small employer insurer
or an intermediary from providing a small employer with information about an established geographic service area or a restricted network provision of the small employer insurer.
(3) (a) Except as provided in par. (b), a small employer insurer may not, directly or indirectly, enter into any contract,
agreement or arrangement with an intermediary that provides for
or results in compensation to an intermediary for the sale of a
health benefit plan that varies according to the health status,
claims experience, industry, occupation or geographic location of
the small employer or eligible employees or dependents.
(b) Payment of compensation on the basis of percentage of
premium is not a violation of par. (a) if the percentage does not
vary based on the health status, claims experience, industry, occupation or geographic area of the small employer or eligible employees or dependents.
(4) A small employer insurer may not terminate, fail to renew
or limit its contract or agreement of representation with an intermediary for any reason related to the health status, claims experience, occupation or geographic location of the small employers
or eligible employees or their dependents placed by the intermediary with the small employer insurer.
(5) A small employer insurer or an intermediary may not induce or otherwise encourage a small employer to separate or otherwise exclude an employee from health coverage or benefits provided in connection with the employee’s employment.
(6) Denial by a small employer insurer of an application for
coverage from a small employer shall be in writing and shall state
the reason or reasons for the denial.
(7) A 3rd-party administrator that enters into a contract,
agreement or other arrangement with a small employer insurer to
provide administrative, marketing or other services related to the
offering of health benefit plans to small employers in this state is
subject to this chapter as if it were a small employer insurer.
(8) The commissioner may by rule establish additional stan-

dards to provide for the fair marketing and broad availability of
health benefit plans to small employers in this state.

‹ Prev All Wisconsin sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.